Type 2 Diabetic Patient-Centered Care
Somjit Prueksaritanond MD, DTM&H*, Saisunee Tubtimtes BSc, MSc*, Kornthong Asavanich MD*, Vasunee Tiewtranon MD*
Affiliation : * Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Background : The prevalence of diabetes mellitus has increased worldwide including Thailand. Management
of diabetes should be considered biological and psychosocial. Patient-centered care was applied in the
present study. Patient-centered care is a process interaction between the clinician and the patient. It refers
to the clinician’s behavioral skill in the consultation. Patient-centered care customizes seeking and accepting
the patient’s ideas, seeking and giving recognition and encouragement, treatment recognition and decision
making in response to the individual patient’s perspective.
Objective : To evaluate the efficacy of patient-centered care on type 2 diabetes mellitus. Their fasting plasma
glucose (FPG), hemoglobin A1c (HbA1c), eating and exercise behavior, compliance, symptoms of diabetes
as well as satisfaction were compared before and after the intervention.
Materials and Methods : The quasi-experimental design (controlled before and after intervention)) was
conducted among 78 patients with type 2 diabetes mellitus who regularly attended the outpatient clinic,
Family Medicine Department, whose FPG was more than 150 mg/dL, non pregnant, could communicate
well in Thai and had no other complications. The patients were required to follow on Wednesday morning
every 6-10 weeks for one year. A group of 6-10 patients was appointed in each visit. The six interconnecting
components of patient-centered care were applied. (1) The patients and the researchers were introduced to
each other to enhance the relationship between the patients, doctors and researchers. (2) In each visit, by
using a group process and individual approach, the authors explored, assessed and analyzed both the
disease, the illness (patient’s ideas, feelings, expectations and functions), drug compliance, eating and
exercise behavior. (3) The patient’s life, family history, psychological and social behaviors were emphasized.
(4) Setting the goals of FPG level that is achievable and agreeable to both the physician and patients, (5)
Each patient was required to attend both nutrition and exercise education workshops. (6) Self care and self
records on food items as well as nutrition and exercise practice were emphasized in order to incorporate
them into their lifestyle.
Results : There were 53 females (67.9%) and 25 males (32.1%). Average age was 57.2 years. Diabetes dura-
tion was 6.75 + 5.45 years. Mean FPG of overall subjects decreased 43.07 + 76.32 mg/dL. About 16.44% had
FPG below 126 mg/dL. 55.13% retained the same hypoglycemic medications, 10.5% had decreased dosage.
Amongst 33 subjects (42.3%) who completed the program, FPG decreased 73.58 + 70.99 mg/dL (p < 0.000).
HbA1c decreased 0.92 + 1.41% (p = 0.001). Eating behavior (p < 0.000) and exercise behavior (p < 0.05)
were better. Symptoms of diabetes were improved. Patient’s satisfaction indicated that they had a better
understanding of the disease and illness. They were eager to share their experiences with others and able to
develop a relationship with the health care team. Amongst 45 patients (57.7%) who partially followed the
program, FPG decreased 39.55 + 68.54 mg/dL (p = 0.001).
Conclusion : Glycemic control of type 2 diabetes subjects was improved by patient-centered care, Eating and
exercise behaviors, compliance, symptoms of diabetes were better. This pilot study showed that the health
status was improved not only by the biological indicators but also by behavior. The present study provided
a beneficial impact on improving the health status of type 2 diabetes.
Keywords : Type 2 diabetes, Care, Patient-centered
